New Rules of Engagement

The world of radiology is changing. Here’s how the ACR is positioning the specialty for success.

This will be my last Bulletin column as your chair of the ACR Board of Chancellors. As I look back, being involved in organized medicine, in particular organized radiology, has made my professional life most rewarding.

Over the last 20 plus years, it has been an honor and privilege to work alongside so many talented and dedicated volunteers and, of course, our talented ACR staff. In every task we undertake, we do our best serve our patients, our ACR members, and our specialty.

Your Board of Chancellors is composed of a phenomenal group of men and women who have all of our best interests at heart. But even more importantly, it is the hundreds of volunteers on our committees and commissions who are doing the true work of the College. Quite frankly, I am embarrassed to say, the board chair doesn’t do all that much. Mostly, I have played the role of head cheerleader, extolling all the great things our volunteers and staff are doing on behalf of all of us. And so, once again, my thanks go not just to all of the board members who have made my job easy, but to every volunteer and staff member on every committee in every commission of the College. All of the credit for all we have accomplished goes to you.

It doesn’t take much to realize that our specialty and our practices are stronger because of the ACR. Our strategic plan emphasizes that the College exists to help our members provide their own value to our patients, referring physicians, and health systems. The College is our partner as we deal with the transition to value-based reimbursement and alternative payment models. Now is the time for all of us to become more engaged with the College.

I used to believe that the ACR could do everything it needed to do for radiologists behind the scenes, without requiring any real active engagement from the vast majority of our members. But the days when the ACR can do all its work for us in the background have passed. While I am certain the College will be able to develop the groundwork with policymakers and create the tools that will make us successful in the years ahead, that success will require our engagement — and I mean active engagement.

Fifteen years ago, when I was our Relative Value Scale Update Committee advisor, radiology was expanding. Exciting new technology and services were coming into the mainstream of clinical practice. The ACR Commission on Economics worked to get new Current Procedural Terminology (CPT) codes and reasonable relative value unit valuations for these new services, and, for the most part, radiologists benefited if their billing offices learned to use the new codes. No need for active engagement. Our Commission on Quality and Safety created practice parameters and appropriate use criteria. While most of us had these on the shelf, they were not something many of us used on daily basis. Over time, things changed a little. Our practice parameters became the basis for the accreditation programs and our appropriateness criteria are now the basis for clinical decision support for our referring physicians. Both of these require a bit more interaction and modest engagement on our part, but this is just the beginning.

Another area of future growth is reporting metrics for value-based payments to CMS. These metrics will expand significantly in the coming years. While many of us are familiar with claims-based reporting for the Physician Quality Reporting System (PQRS), I am concerned that many practices — if not most — are at risk for payment reductions because of PQRS under reporting. And that’s a shame. The ACR has worked with CMS to ensure that we have enough reportable measures to prevent penalties. Most of these measures are meaningful for patient care, and most of us are already fulfilling the requirements for the vast majority of these measures.

The problem is difficulty in reporting.

Recently CMS promoted registry reporting for PQRS through Qualified Clinical Data Registries. The ACR has built registries to handle almost all of the PQRS metrics. However, most practices are still using claims-based reporting systems, and many have not kept up with the expanding PQRS reporting requirements. As we move into the Merit-based Incentives Payment System (MIPS), claims-based systems will likely not be able to capture all the necessary information. This information will have to be recorded as part of our workflow by our PACS, RIS, electronic health records, or dictation systems. Very few practices will be able to invest the resources to develop software to capture the requisite information — and most wouldn’t want to. But the ACR will.

The ACR will be your partner to ensure you have the ability to capture what you do for your patients as part of your workflow and report that data to CMS and other payers. However, this requires a level of radiologist engagement that historically we have not needed. We will have to actively participate by sharing data with registries and convincing our health IT partners that registry reporting is a necessary part of their framework. Furthermore, once these reporting systems are in place, radiologists will need to monitor the data collection and ensure relevant information is being captured.

Most importantly, radiologists should become engaged in data analytics as our practices are benchmarked against national norms. This mechanism of continuous professional improvement is the real strength of data aggregation in registries. We should be actively using our practice data to improve patient care in real time and then providing this information to our patients and health systems.

Another way practices can become more engaged with the College is to support our colleagues who volunteer on the committees and commissions of the College. Compared to a decade ago, getting time away from our practices to participate in organized medicine is becoming more difficult. Working harder in our practices means less time to volunteer. However, the need remains for a robust cadre of volunteers to do the work of the College.

With a new slate of officers, our wonderful board, and an unsurpassed group of volunteers, I have no doubt we will foster even stronger partnerships between our members and the College and garner the active engagement that will indeed make ACR members “universally acknowledged as leaders in the delivery and advancement of quality healthcare,” just as our strategic plan outlines. Our future begins now.